DARCO HEADED CANNULATED SCREWS 151677-0 The following languages are included in this packet: English (en) Deutsch (de) Nederlands (nl) Français (fr) Español (es) Italiano (it) Português (pt) 中文 - Chinese (sch) Türkçe (tk) For additional languages, visit our website www.wmt.com. Then click on the Prescribing Information option. For additional information and translations please contact the manufacturer or local distributor. M C 0086* P Wright Medical Technology, Inc. Wright Medical UK Ltd. 1023 Cherry Rd. 3rd Avenue Memphis, TN 38117 Letchworth U.S.A. Hertfordshire, SG6 2JF UK * The CE-Marking of Conformity is applied per catalog number and appears on the outer label, if applicable. April 2014 Printed in U.S.A
Attention Operating Surgeon IMPORTANT MEDICAL INFORMATION DARCO HEADED CANNULATED SCREWS (151677-0) EN OUTLINE: I. GENERAL PRODUCT INFORMATION A. PATIENT SELECTION B. INDICATIONS C. CONTRAINDICATIONS D. POTENTIAL COMPLICATIONS AND ADVERSE REACTIONS E. PRECAUTIONS F. HANDLING & STERILIZATION G. STORAGE CONDITIONS
DEFINITIONS Symbols and abbreviations may be used on the package label. The following table provides the definition of these symbols and abbreviations. Table 1. Definitions of Symbols and Abbreviations Symbol g h D Y i H l p Definition Batch code Catalog number Do not re-use Caution, consult accompanying documents Consult operating instructions Use by Temperature limitation Keep dry Keep away from sunlight
N M P I K Date of manufacture Manufacturer Authorized EC Representative in the European Community Sterilized using ethylene oxide Sterilized using radiation STERILE GAS Sterilized using gas plasma J Sterilized using aseptic processing techniques For prescription use only Abbreviation Ti Ti6Al4V CoCr SS UHMWPE Material Titanium Titanium Alloy Cobalt Chrome Alloy Stainless Steel Ultra High Molecular Weight Polyethylene
I. GENERAL PRODUCT INFORMATION Through the advancement of surgical fusion hardware, the surgeon has been provided a means of correcting deformity and reducing pain for many patients. While the implants used are largely successful in attaining these goals, it must be recognized that they are manufactured from metal, and that no implant can be expected to withstand the activity levels and loads as would normal, healthy bone after fusion occurs. The surgeon must evaluate each situation individually based on the patient s clinical presentation in making any decisions regarding implant selection. Surgeons must be familiar with the applicable operative technique and instructions for use for each product. This package insert and immediate package label contain essential warnings and precautions for each surgery. Additionally the surgical technique should be referenced for detailed information about implant selection, relevant product details, proposed surgical instructions, and/or assembly use. The surgeon should contact Wright for the proposed product-specific surgical technique. In using fusion implants, the surgeon should be aware of the following: The correct selection and sizing of the implant is extremely important. Selection of the proper size, shape, and design of the implant increases the potential for success. The implants require careful seating and adequate bone support. In selecting patients for surgery, the following factors can be critical to the eventual success of the procedure: 1. Patient s occupation or activity. If the patient is involved in an occupation or activity which includes substantial lifting or muscle strain, the resultant forces can cause failure of the fixation, the device, or both. The implant will not restore function to the level expected with normal healthy bone, and the patient should not have unrealistic functional expectations. 2. Condition of senility, mental illness, or alcoholism. These conditions, among others, may cause the patient to ignore certain necessary limitations and precautions in the use of the implant, leading to failure or other complications.
3. Foreign body sensitivity. Where material sensitivity is suspected, appropriate tests should be made prior to material selection or implantation. A. PATIENT SELECTION Use of surgical fusion hardware requires consideration of the following general indications: Good condition of the patient Good neurovascular status Adequate skin coverage Possibility of a functional musculotendinous system Adequate bone stock to receive implant Availability of post-operative therapy Cooperative patient B. INDICATIONS DARCO HEADED CANNULATED SCREWS DESCRIPTION The DARCO Headed Cannulated Screws are available in various sizes, thread types, and lengths. The screws contain a hex drive interface and an optional washer is available with the system. The screws and washers are manufactured from titanium alloy. INDICATIONS The DARCO Headed Cannulated Screws are intended for use over a guide pin or wire for bone fracture fixation and bone fragment fixation. Wright s washers may be used with the screws in cases where the patient has poor bone quality.
Minimally invasive fracture/ joint reconstruction Multiple-fragment joint fractures Simple metaphyseal fractures Simple epiphyseal fractures Fractures of the head of the humerus Fractures of the head of the tibia Cooper fractures of the tibia Fractures of the radius Fractures of the wrist, ankle, elbow and shoulder Scaphoid fractures and other fractures of the hand Metatarsal fractures and other fractures of the foot Ligament fixation of the proximal humerus Ligament avulsion injuries (Apohysis) Fractures of small joint bones Malleolar fractures Navicular fractures Fractures of the calcaneus and talus Arthrodesis of the ankle joint Avulsion fracture and metatarsal V Fractures of the tarsal region
C. CONTRAINDICATION Inflammation, sepsis and osteomyelitis are absolute contraindications. All applications that are not defined by the indications are contraindicated. In addition, surgical success can be adversely affected by: Acute or chronic infections, local or systemic Vascular, muscular or neurological pathologies that compromise the concerned extremity All concomitant pathologies that could affect the function of the implant Osteopathies with reduced bone substance that could affect the function of the implant Any mental or neuromuscular disorder that could result in an unacceptable risk of failure at the time of fixation or complications in post-operative treatment. Known or suspected sensitivity to metal Corpulence; an overweight or corpulent patient can strain the implant to such a degree that stabilization or implant failure can occur Whenever the use of the implant comes into conflict with the anatomical structures of physiological status Other medical or surgical pre-conditions that could compromise the potentially beneficial procedure, such as: The presence of tumors Congenital abnormalities Immunosuppressive pathologies Increased sedimentation rates that cannot be explained by other pathologies Increased leukocyte (WBC) count Pronounced left shift in the differential leukocyte count
D. POTENTIAL COMPLICATIONS AND ADVERSE REACTIONS In any surgical procedure, the potential for complications exists. The risks and complications with these implants include: loosening, deformation or fracture of the implant acute post-operative wound infections and late infections with possible sepsis migration, subluxation of the implant with resulting reduction in range of movement fractures resulting from unilateral joint loading thrombosis and embolism wound hematoma and delayed wound healing temporary and protracted functional neurological perturbation tissue reactions as the result of allergy or foreign body reaction to dislodged particles. corrosion with localized tissue reaction and pain pain, a feeling of malaise or abnormal sensations due to the implant used bone loss due to stress shielding All possible complications listed here are not typical of WMT products but are in principle observed with any implant. Promptly inform WMT as soon as complications occur in connection with the implants or surgical instruments used. In the event of premature failure of an implant in which a causal relationship with its geometry, surface quality or mechanical stability is suspected, please provide WMT with the explant(s) in a cleaned, disinfected and sterile condition. The manufacturer cannot accept any other returns of used implants. The surgeon is held liable for complications associated with inadequate asepsis, inadequate preparation of the osseous implant bed in the case of implants, incorrect indication or surgical technique or incorrect patient information and consequent incorrect patient behavior.
E. PRECAUTIONS Following the instructions for use provided in product literature can minimize the potential for complications or adverse reactions with any implant. It is the responsibility of each surgeon using implants to consider the clinical and medical status of each patient and to be knowledgeable about all aspects of implant procedure and the potential complications that may occur. The benefits derived from implant surgery may not meet the patient s expectations or may deteriorate with time, necessitating revision surgery to replace the implant or to carry out alternative procedures. The patient s mental status must also be considered. Willingness and/or ability to follow post-operative instructions may also impact the surgical outcome. Surgeons must balance many considerations to achieve the best result in individual patients. Instructions on combining implants can be found in the corresponding surgical technique. Wright has tested combinations using implants and instruments for the manufacturers Wright and aap; any other combination is at the risk and hazard of the surgeon. IF EXCESSIVE LOADING CANNOT BE PREVENTED, AN IMPLANT SHOULD NOT BE USED. The main goal of surgery with this implant is to establish bony fusion. Abnormal or excessive forces could lead to delayed union, non-union, or failure of the implant. Abnormal force loading and subsequent wear may be caused by: Uncorrected instability Improperly sized implant Inadequate soft tissue support Implant malposition Excessive motion Uncorrected or recurrent deformity Patient misuse or overactivity
Proper fixation at the time of surgery is critical to the success of the procedure. Bone stock must be adequate to support the device. Some preventative measures to consider minimizing the potential for complications: Follow guidelines for indications and contraindications Identify prior pathology Stabilize collapse deformities Bone graft pre-existing cysts Use a properly sized implant Avoid K-wires and sutures through the implant Avoid flawing implant surfaces or excessive bending to minimize the potential for early fatigue failure. If complications develop, possible corrective procedures include: Implant removal Synovectomy Bone grafting of cysts Replacement of the implant Removal of the implant with fusion of the joint Over time, metallic implants may loosen, fracture, or cause pain after the bone fracture or osteotomy is healed. Removal of metallic implants is at the surgeon s discretion, and the appropriateness of the selected procedure will be based on the surgeon s personal medical training and experience. It is imperative that adequate post-operative care and protection be provided by the surgeon.
Recommendations Regarding Device Fragments Use medical devices in accordance with their labeled indications and the manufacturer s instructions for use, especially during insertion and removal. Inspect devices prior to use for damage during shipment or storage or any out-of-box defects that might increase the likelihood of fragmentation during a procedure. If the device is damaged, retain it to assist with the manufacturer s analysis of the event. Carefully consider and discuss with the patient (if possible) the risks and benefits of retrieving vs. leaving the fragment in the patient. Advise the patient of the nature and safety of unretrieved device fragments including the following information: a. The material composition of the fragment (if known); b. The size of the fragment (if known); c. The location of the fragment; d. The potential mechanisms for injury, e.g., migration, infection; e. Procedures or treatments that should be avoided such as MRI exam in case of metallic fragments. This may help reduce the possibility of serious injury from the fragment. Clinical results depend on surgeon and technique, pre-operative and post-operative care, the implant, patient pathology and daily activity. It is important that surgeons obtain appropriate informed consent and discuss the potential for complications with each patient prior to surgery. This may include a review of alternative, non-implant procedures such as soft tissue reconstruction or arthrodesis.
Concerning Magnetic Resonance Environments There are inherent risks associated with the use of metallic implants in the MR environment; including component migration, heat induction, and signal interference or distortion near the component(s). Heat induction of metallic implants is a risk related to component geometry and material, as well as the MR power, duration, and pulse sequence. Since MR equipment is not standardized, the severity and likelihood of occurrence are unknown for these implants. DARCO Headed Cannulated Screws have not been evaluated for safety and compatibility in the MR environment. DARCO Headed Cannulated Screws have not been tested for heating or migration in the MR environment. Since these devices have not been tested, Wright cannot make a recommendation for the use of MRIs with these implants, neither for safety considerations nor imaging accuracy. These components are passive metallic devices, and as with all passive devices, there is potential for reciprocal interference with certain imaging modalities; including image distortion for MR and X-ray scatter in CT. F. HANDLING AND STERILIZATION When removing the medical devices from the packaging, inspect the integrity of the medical devices and the correspondence of the device type and size with the labeling. Damaged medical devices must not be used. WMT is solely responsible for the medical devices and their supply presentation. Any change made to these results in a new medical device for which WMT assumes no responsibility. The required instrument set can be ordered from WMT. Please see the Surgical Technique for further details on implantation of the components and on the instrument set. IMPLANTS The implants described in this package insert are provided non-sterile as indicated on the individual product s label. Implants that are presented in instrument trays are provided non-sterile.
Implants provided non-sterile should be processed according to the recommended parameters for instruments (below). This product is for single use only. An implant should never be re-sterilized after contact with body tissues or fluids. Devices labeled for single-use only should never be reused. Reuse of these devices may potentially result in, but are not limited to, significant degradation in device performance, cross-infection, or contamination which may result in serious patient harm. INSTRUMENTS Surgical instruments (and non-sterile implants) should be cleaned and sterilized according to the following parameters: Cleaning 1. Disassemble all components as per manufacturer instructions (if appropriate). 2. Rinse with cold tap water to remove gross contamination. 3. Bathe in an enzymatic detergent solution prepared per manufacturer directions for 5 minutes. 4. Scrub thoroughly with a soft brush and/or pipe cleaner; repeatedly flush any very narrow lumens with enzymatic detergent solution using a syringe. 5. Rinse with cold tap water for a minimum of one minute; use a syringe to repeatedly flush any very narrow lumens. 6. Bathe in a detergent solution prepared per manufacturer directions for 5 minutes. 7. Scrub thoroughly with a soft brush and/or pipe cleaner; repeatedly flush any very narrow lumens with detergent solution using a syringe. 8. Rinse thoroughly/flush with deionized/reverse osmosis (RO/DI) water.
9. Sonicate for a minimum of 10 minutes in an enzymatic detergent solution prepared per manufacturer directions. 10. Rinse thoroughly/flush with RO/DI water. 11. Dry with a clean, soft, absorbent, disposable cloth. 12. Visually inspect for cleanliness. All visible surfaces, internal and external, should be visually inspected. If necessary re-clean until it is visibly clean. Note: Brushes (i.e. pipe cleaners) could be used for cleaning most lumens, however, the use of a syringe to flush narrow lumens with diameters less than or equal to 0.041 inches is recommended. Sterilization The minimum recommended steam sterilization conditions for Wright reusable instruments are as follows: 1. Double wrap the component in an FDA-cleared CSR wrap or similar type non-woven medical grade wrapping material. 2. Autoclave according to the following parameters: Steam Sterilization Cycle Type Parameter Minimum Set Point Prevacuum Exposure Temperature 270 F (132 C) 270 F (132 C) Exposure Time 4 minutes Dry Time 20 minutes
3. After sterilization, remove the component from its wrapping using accepted sterile technique with powder-free gloves. Ensure that implants are at room temperature prior to implantation. Avoid contact with hard objects that may cause damage. These recommendations are consistent with AAMI ST79 Table 5 guidelines and have been developed and tested using specific equipment to achieve a Sterility Assurance Level (SAL) of 10-6. Due to variations in environment and equipment, it must be demonstrated that these recommendations produce sterility in your environment. If processing conditions, wrapping materials, or equipment changes occur, the effectiveness of the sterilization process must be demonstrated. For additional information see Wright s Cleaning and Handling of Wright Medical Instruments. G. STORAGE CONDITIONS All implants must be stored in a clean, dry environment and be protected from sunlight and extremes in temperature. DARCO is a licensed trademark of Wright Medical Technology, Inc.